Abstract 15: Quality of Basic Life Support by EMT-D in an Urban Setting - Is it Satisfying?
Introduction: Despite changes in protocols and introduction of new methods and devices e.g. automated external defibrillators (AED) the survival rate of pts with cardiopulmonary resuscitation (CPR) after out-of-hospital sudden cardiac death (SCD) remains low. It is speculated that poor performance and/or invalid assumptions regarding the efficacy of actual CPR protocols may influence unsatisfactory outcome. We therefore evaluated the efficacy of out-of-hospital basic life support performed by first responder emergency medical technicians (EMT-D) equipped with an AED.
Methods: Data from the 2-tiered Berlin EMS were analyzed, the information on rhythm of victims and voices of rescuers being stored in the memory of the AED devices used by the 1st tier EMT-Ds (median alarm-scene interval 6 min, 95% within 11 min). Information on rhythm, CPR skills (protocol according to the 2000 guidelines of the European Resuscitation Council), and interruptions were evaluated.
Results: Through 2004, 365 resuscitations were analyzed (age 69±16 years, 60% male), 24% of pts surviving to hospital admission. Bystander CPR was performed in 12% and VF as first rhythm was detected in 26%. The interval of start of EMS CPR to start of CPR the 2nd tier was 6min (3–10min). The total no-flow-time (NFT: time without chest compressions) was 60% of these 6min. NFT consisted of a median interval of 34sec (9sec-1min) from switch on of the AED to start of chest compression, a total duration of CPR interruptions due to AED rhythm analysis or pulse checks of 98sec (56–152sec) and of 86sec (37–155sec) for bag valve ventilations. Chest compressions (110bpm, 102–122bpm) were only performed for a total time of 160sec (80–280sec) between interruptions, the effective compression frequency thus decreasing to 50bpm (45–59bpm).
Conclusion: The 2000 BLS algorithm leads to long periods of NFT of CPR due to unacceptably long periods of interruption of chest compressions which may decrease survival. These findings strongly support recent changes in BLS algorithms with longer periods of chest compression and less interruptions for rhythm diagnosis and ventilation. Our results underline the importance of evaluation of CPR procedures under real life conditions in assessment of quality of care.